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See a sample rate comparisonCPT 23430 Fee Schedule
Medicare rates as of October 2026
CPT 23430 is classified under Surgery, in the Surgical Procedures on the Musculoskeletal System subgroup.
Move Tendon In Upper Arm, Surgery To Cut The Normal Attachment Of The Biceps Tendon On The Shoulder Socket And Reattach It To The Arm Bone. The Procedure Treats Biceps Tendon Inflammation Or Injury.
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | 24Ambulatory Surgical Center 22On Campus Outpatient Hospital |
| Common Modifiers | RTRight side of body LTLeft side of body |
| Hospital Outpatient Group (APC) | APC 5114 - Level 4 Musculoskeletal Procedures |
| Surgery Center Payment (ASC) | J8 - Device-intensive procedure, paid at an adjusted rate |
| Common Revenue Codes | 03600975Sign up to view all 7 |
| Medicare Fee Schedule | $696.41 national non-facility rate (2026)View Medicare rates for 23430 |
| Medicaid Fee Schedule | $556.51 median of the 8 states in the free previewView Medicaid rates for 23430 |
National average reimbursement for CPT 23430 by major payers:
$974.78
BCBS / Anthem
$1,007.95
UnitedHealthcare
$1,065.45
Aetna
$1,227.18
Cigna
Compare published rates across providers.
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CPT 23430
5 of 25 sample ratesHigher to lower in this preview
Metropolitan Medical Partners LLC, Surgery Center Of Chevy Chase
Metropolitan Medical Partners Ll
$5,249.00Published rateTalisa Forest
$2,016.47Published rateChildren'S Eye Care Of Northern Colorado PC
$1,053.01Published rateArwen Christian
$864.40Published rateLucy Mudie
$623.21Published rate
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See a sample payer proposalCPT 23430 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The table lists codes related to 23430. Select one to see its fee schedule.
| Code | Description |
|---|---|
| 23430-CPT | Move Tendon In Upper Arm, Surgery To Cut The Normal Attachment Of The Biceps Tendon On The Shoulder Socket And Reattach It To The Arm Bone. The Procedure Treats Biceps Tendon Inflammation Or Injury. |
| 23440-CPT | Surgery On Upper Arm Tendon, Surgery To Remove Biceps Tendon From Original Attachment On Shoulder Socket And Transplant To Upper Arm Bone. |
| 23450-CPT | Capsulorrhaphy Anterio; Putti-Platt Proc Or Magnuson Typ Opera, Capsulorrhaphy Anterior; Putti-Platt Procedure Or Magnuson Type Opera |
| 23455-CPT | Repair Shoulder Capsule, Reattachment Of Shoulder Joint Capsule And Cartilage Without Bone Transfer With Repair Of Shoulder Rim |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 23430. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 23430 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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Frequently Asked Questions
What APC is CPT 23430 assigned to?
Medicare's hospital outpatient payment system (OPPS) assigns CPT 23430 to APC 5114 (Level 4 Musculoskeletal Procedures). An APC groups outpatient services that Medicare pays at the same base rate.
How does Medicare pay for CPT 23430 in an ambulatory surgery center?
CMS lists CPT 23430 with ASC payment indicator J8: Device-intensive procedure, paid at an adjusted rate.
Which revenue codes are billed with CPT 23430?
Hospital price transparency files list CPT 23430 under these revenue codes: including 0360, 0975, 0960, 0490 and 0989. A revenue code names the hospital department or charge category for the line; it does not change what the service is.